Full Time
$5-$6
40
Feb 9, 2026
About Us
We are a fast growing healthcare organization with MSO support for claims, provider payments, and capitation. Our Utilization Management (UM) team ensures accurate service review, compliant adjudication, and efficient payment workflows.
Key Responsibilities
- Review and adjudicate claims for accuracy, coding, and medical necessity
- Monitor utilization patterns, compliance, and high?risk codes
- Support audits, policy development, and clinical review
- Track capitation pools, analyze cost drivers, and prepare performance reports
- Manage provider payments: reconciliation, allocation, and reporting
Qualifications
- 2+ years in UM, billing, claims, or revenue cycle
- Strong knowledge of CPT, ICD-10, modifiers, and medical necessity
- Experience with MSO/IPA/payor or specialty practice preferred
- Familiarity with capitation models and financial analytics valued
- Detail-oriented, analytical, and strong communicator
- EHR/PM experience (NextGen, Epic, etc.) and Excel/Sheets proficiency preferred
For interested applicants, please send your cover letter and resume addressed to Dr. Yi Jiang at